Hand anatomy Movement of finger/thumb: - Flexion: closed fist - Extension: open fist - Abduction: spread fingers out - Adduction:

close fingers in - Opposition (thumb): touch thumb it fingers Joints of hand Skeleton: 3 segments - Carpal bones of wrist - Metacarpal bones of hand (heads of metacarpals = knuckles) - Phalanges of the digits Movements of joints - Midcarpal and Radiocarpal: flexion, extension, abduction and adduction - Carpometacarpal of digits 2-5: flexion, ext, abd, add, and rotation - Thumb carpometacarpal: flex, ext, abd, add, and rotation - Metacarpophalangeal (MP): flex, ext, abd, add, and limited rotation - Interphalangeal (IP) of digits 2-5: flex, ext - IP of thumb: flex, ext Anatomical snuff box - bordered by tendons of abductor pollicis longus and the extensor pollicis brevis (inferior/laterally) and the tendon of extensor pollicis longus (superior/laterally) - Radial artery lies in floor (damaged due to laceration or trauma to back of hang) - Radius and scaphoid articulate deep to snuffbox and take brunt to force when someone falls onto s outstretched hand (scaphoid often broken) Carpal bones: (some lovers try positions that they cant handle) - Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate Intrinsic muscles of the hand - Thenar muscles of thumb: median nerve o Abductor pollicis brevis (abducts 1st metacarpal) o Flexor pollicis brevis (flexes 1st metacarpal) o Opponens pollicis (rotates 1st metacarpal to position thumb during opposition with other digits) - Hypothenal muscles of little finger: ulnar nerve o Abductor digiti minimi o Flexor digiti minimi o Opponens digiti minimi - Interossei: ulnar nerve o Produce abduction or adduction and act with lumbricals for MP flexion and IP extension o Dorsal interossei: abduct o Palmar: adduct - Lumbricals (1,2 - median nerve; 3,4 ulnar nerve) o Sublet precise flexion of MP and extension of IP via attachment btwn tendon of FDP to extensor hood on dorsal side of digits - Adductor pollicis: ulnar nerve o Adducts thumb, brings It back toward palm of hand Summary: - Median nerve: thenar muscles of thumb, first 2 lumbricals - Ulnar nerve: Hypothenal muscles, all interossei, adductor pollicis, lumbricals 3,4 Cutaneous nerves: - Palmar surface

o Ulnar nerve: pinky and half of ringer finger o Median nerve: half of ring, digits 1,2 3, most of hand except for base o Radial nerve: small semicircle below thumb - Dorsal surface o Ulnar nerve: pinky, ulnar side of hand, of ring finger o Median nerve: far tips of digits 1,2, 3, and half of ring finger o Radial nerve: radial side of hand Nerve injuries - Ulnar nerve lesions (at elbow due to fracture of medial epicondyle) o Cause claw hand due to effect on intrinsic and extrinsic muscle s of hand o Pt cant add/abd fingers due to loss of interossei o Pt cant grip squeeze paper if placed btwn fingers - Median nerve lesion (at wrist due o suicide attempt_ o Recurrent branch of median nerve damaged at base of thenar eminence, median nerve compressed as in CTS o Thumb rests in plane of hand, pt cant oppose thumb and little finger o Pt cant grip an object to pick it up - Radial nerve lesion (fracture at shaft of humerus) o Deep radial nerve damage adjacent to neck of radius or damage to radial nerve in upper arm o Pt cant extend wrist or MP joint, can still extend digits o Thumb has cutaneous innervation as superficial radial nerve already has branched off
Nerve Lesion Ulnar N
-at elbow, fracture of medial epicondyle or dislocation of elbow - Klumpkes palsy

Median N
-at wrist in attempted suicide

Radial N
-fracture of humerus shaft

Deficit Claw hand due to effect on both intrinsic and extrinsic muscles in chronic state Pt cannot AD or ABduct their fingers Loss of sensory innervation to little finger and hypothenar eminence Ape hand in chronic state Pt cannot oppose thumb and finger Loss of sensory innervation to thenar eminence Pt cannot extend wrist Loss of sensory innervation to dorsal surface of hand

Clinical Test Patient unable to grip or squeeze a piece of paper if placed between their fingers Pt cant grip an object to pick it up

Pt can still extend digits due to lumbricals

Muscle Thenar muscles of thumb

Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis

Innervation Anatomical Function Median n (recurrent Abduct, flex and oppose the thumb branch) Ulnar n Abduct, flex and oppose the 5th digit

Hypothenal muscles of little finger

Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi

Interossei Lumbricals Adductor pollicis

Ulnar n 1st, 2nd median n 3rd, 4th ulnar n Ulnar n

Dorsal Abduction, Extend IP, Flex MP Palmar Adduction, Extend IP, Flex MP Extend IP joint, Flex MP joint Brings thumb into the palm of the hand